BACKGROUND: Proximal humeral fracture fixation can provide a more stable fixation, has a stronger biomechanical stability, but open reduction and fixation will cause extensive soft tissue dissection and heavy damage to the rotator cuff. Closed wear nail has a high failure rate of fixation, fracture re-displacement and other defects.
OBJECTIVE: To investigate the technical methods of applying closed reduction, percutaneous pinning anatomical external fixation in repair of proximal humeral fracture, and to analyze the application characteristics
and safety in different types of proximal humerus fractures.
METHODS: Based on the special anatomical structure of proximal humerus, a shoulder external fixator has been independently researched and developed by author. The clinical data of 23 patients treated with closed reduction and percutaneous pinning anatomical external fixation (homemade) because of proximal humerus fracture at the Department of Traumatology, Tianjin Hospital during March 2010 to March 2014 were retrospectively analyzed. In accordance with Neer classification type, there were 19 cases of 2-part fractures of the humerus, 4 cases of 3-parts fractures of the humerus, with greater tuberosity avulsion fractures, which were all fresh fractures and were treated with closed reduction pinning and external fixation. Regular follow-up was conducted after treatment. Radiographic assessment, pain and function evaluation were conducted during follow-up, so as to work out the functional recovery, determine the final repair result.
RESULTS AND CONCLUSION: All patients were followed up for 6-24 months. Totally 23 patients initially healed in fracture within 8 weeks. After treatment, visual analogue pain score of patients was 0.8 points. In the final follow-up, the American Shoulder and Elbow Surgery Association of shoulder function scoring system (ASES) score was an average of (91.7±2.6) points, Constant shoulder function score was an average of (88.3±4.7) points, the University of California (UCLA) shoulder joint scoring system score was (31.9±3.1) points, simple shoulder test (SST) system score was an average of (9.6±2.4) points. The shoulder function assessment (UCLA score) of these 12 patients was excellent, of 9 cases was good, and of 2 cases was poor. The excellent rate reached 91% after treatment. These results suggest that the application of closed reduction, percutaneous nailing anatomical external fixation in repair of proximal humerus fractures has the features of stable fixation, and small damage of soft tissue. Standardizing the angle of closed nailing and entrance point, fixing from the intersection of three planes in arcuate-shape and connecting with external fixation can achieve a more stable fixed effects.